decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 4 (April)
Medication management: 90862 or, not and, an E/M
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Article Overview
This article reviews coding issues for medication management in behavioral health, with emphasis on how CPT guidance has historically treated pharmacologic management in relation to evaluation and management services. It is written for physicians, coders, and billing staff who need to understand when a medication-management visit may be captured by an E/M service and when other CPT categories are discussed as alternatives. The article also touches on payer coverage concerns, face-to-face versus non-face-to-face contact, and references CPT Assistant and AMA editorial commentary.
Why This Topic Matters
Medication-management encounters are common in behavioral health and ADHD care, and the reporting approach can affect whether a claim is payable and how the service is represented. Understanding the article helps readers recognize the distinction between standalone medication management and broader E/M services.
Article Sections
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Medication management and CPT guidance
Introduces the topic of medication management for psychotropic medications and summarizes the CPT-based context for reporting these services.
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CPT Assistant discussion of 90862
Summarizes the historical CPT Assistant discussion of this service category and the situations in which it was described.
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Relationship to E/M services
Explains the article’s discussion of how medication-management work may be reflected when an E/M service is also provided.
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Face-to-face versus non-face-to-face contact
Addresses whether the service must occur in person and references other CPT categories discussed for telephone and email-based contact.
What You Will Learn
- How the article frames medication management within CPT reporting concepts
- How historical CPT Assistant guidance is discussed in relation to behavioral health services
- What general issues are raised when comparing medication management with E/M reporting
- What the article says about in-person and non-in-person contact for this type of service
Who Should Read This
- Physicians
- Psychiatrists
- Behavioral health providers
- Medical coders
- Billing staff
- Practice managers
Codes Discussed
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